Summary: There was no fault in the care provided to Mrs X’s grandmother (Mrs Y) in the period after she had sustained an injury. The Council-commissioned care provider took steps to ensure the care was in line with Mrs Y’s wishes, and it updated her care and support plan. There was also no fault in how the Council responded to Mrs X’s safeguarding concerns or how it communicated the outcome.

The complaint

1. Mrs X complains about the level of care her grandmother was provided by a Council-commissioned care provider during the time her arm was in a plaster cast in 2022. She also complains that:
• Care records for the same period were inaccurate.
• Advice she was given about bathing was misleading.
2. Mrs X also complains about the Council’s response to safeguarding concerns she raised. She says it did not properly communicate the outcomes to her.
3. Mrs X says this caused her distress because she was uncertain about the level of care her grandmother was receiving.
4. I will refer to Mrs X’s grandmother as Mrs Y.

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The Ombudsman’s role and powers

5. We investigate complaints of injustice caused by ‘maladministration’ and ‘service failure’. I have used the word fault to refer to these. We consider whether there was fault in the way an organisation made its decision. If there was no fault in the decision making, we cannot question the outcome. (Local Government Act 1974, section 34(3), as amended)
6. We investigate complaints about councils and certain other bodies. Where an individual, organisation or private company is providing services on behalf of a council, we can investigate complaints about the actions of these providers. (Local Government Act 1974, section 25(7), as amended).
7. If we are satisfied with an organisation’s actions or proposed actions, we can complete our investigation and issue a decision statement. (Local Government Act 1974, section 30(1B) and 34H(i), as amended)

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How I considered this complaint

8. I spoke to Mrs X and considered the information she sent to me.
9. I considered the responses submitted by the Council.
10. I considered the fundamental standards which are incorporated in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
11. Mrs X and the organisation had an opportunity to comment on my draft decision. I considered any comments received before making a final decision.

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What I found

What should have happened

Care provision

12. The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 set out the fundamental standards those registered to provide care services must achieve. The Care Quality Commission (CQC) has issued guidance on how to meet the fundamental standards below which care must never fall.
• Regulation 12 is about safe care and ensuring people are receiving care that avoids them coming to harm or risk of harm.
• Regulation 17 is about good governance. This includes keeping accurate, complete and detailed records about people receiving care, including records of care provided and decisions made about care.

Safeguarding response

13. A council must make enquiries if it thinks a person may be at risk of abuse or neglect and has care and support needs which mean the person cannot protect themselves. An enquiry is the action taken by a council in response to a concern about abuse or neglect. An enquiry could range from a conversation with the person who is the subject of the concern, to a more formal multi-agency arrangement. A council must also decide whether it or another person or agency should take any action to protect the person from abuse. (Care Act 2014, section 42)

What happened

Background

14. In 2010, Mrs Y moved into retirement housing. In 2019, Mrs Y’s care and support plan said care workers would carry out three morning visits a week, each lasting 45 minutes, and an evening visit lasting 30 minutes. The care included support with washing and preparing hot drinks and breakfast.
15. Mrs Y said on her care and support plan, she had a skin condition and had asked for her skin to be checked and prescribed cream to be applied.
16. In early January 2022, Mrs Y fractured her wrist, and her arm was set in a plaster cast. Mrs Y subsequently went into hospital on 16 January and when she was later discharged, she had another care plan, with a different provider.
17. There is no evidence to suggest Mrs Y did not have capacity to make her own decisions in January 2022. Mrs Y is now deceased.

Sequence of events

18. The Council provided me with the care provider care notes for the relevant period. They have also provided me with their contact log relating to Mrs Y.
19. Care workers visited Mrs Y and carried out an ‘early tea visit’ on 1 January lasting 47 minutes and then again before her injury, on 3 and 5 January. Care workers have recorded these as ‘shower/bathing call’ and lasted for 41 and 42 minutes respectively.
20. On 7 January a hospital team updated the care provider about Mrs Y’s injury before it visited her that day. Also that day, a care worker contacted a care provider manager immediately after their care visit. Their notes said Mrs Y was unable to take a shower because of her plaster cast and because she was in pain. The care worker gave Mrs Y a body wash.
21. The care worker visited Mrs Y for 40 minutes and gave her a body wash.
22. Later that day a manager contacted Mrs Y and made a note of the following;
• Mrs Y said she was in pain but had some mobility;
• Mrs Y wanted a body wash until the discomfort had stopped;
• Mrs Y may have to wear a cast for several weeks;
• They advised Mrs Y to get a cover for her cast to allow for a shower.
23. The manager also said they would amend Mrs Y’s care plan and update Mrs Y’s care workers.
24. I have seen a copy of Mrs Y’s care and support plan from before and after her injury, and this contains an update relating to additional support because of a ‘broken arm’.
25. On 8 January a manager contacted a care worker before their visit to Mrs Y. They told them about Mrs Y’s injury and asked them to check her updated care plan.
26. The care records from 8-12 January, show the following;
• 8 January (26 minutes), tea visit, body wash, creams applied;
• 10 January (41 minutes), shower/bathing call, body wash;
• 12 January (41 minutes), assisted with body wash, creams applied.
27. On 10 January, a care worker gave a manager an update about Mrs Y after their visit that day. They said they had not showered Mrs Y because she did not have a cover for her cast. There is a note the care worker had offered to obtain one for Mrs Y the following week.
28. A care provider manager contacted Mrs Y on 12 January to ask how she was. The manager made a note that Mrs Y told her she was in less pain and would want to take a shower soon. The manager asked Mrs Y to obtain a cover for her plaster cast.
29. In the period after Mrs Y had injured her wrist, but before she went into hospital, Mrs X contacted the Council to ask for a revised care and support plan and to increase Mrs Y’s visits to twice daily. Mrs X said she asked for this because Mrs Y had had several falls.
30. Mrs X said her family, who were helping shower Mrs Y, saw she was in discomfort and noticed she had what they described as a pressure sore.
31. A social worker recorded that Mrs X had contacted them on 13 January to ask for increased care support and told them at the same time, they had noticed Mrs Y had a pressure sore. The social worker contacted the care provider the following day and the care provider agreed to increase the number of visits.
32. Mrs X said her family were present during a visit on 14 January when a care worker visited Mrs Y and offered to make her a drink. Mrs X told me that having checked that no drink was needed, the care worker then made to leave and when family members challenged the care worker about washing Mrs Y, the care worker said they had been told not to wash Mrs Y because of the cast.
33. Mrs X contacted the Council a second time, this time to report their concerns that Mrs Y was not being properly cared for, partly because of their concerns about this visit, and partly because they could smell Mrs Y had a body odour as though she was not being washed.
34. The care provider notes for 14 January, says a care worker visited Mrs Y for 43 minutes, assisted her with a body wash and applied creams.
35. The social work case reports on 14 January, have a record of Mrs X’s concerns about this visit. It also has a note of contact the social worker had with the care provider about Mrs X’s concerns. The social worker also completed a safeguarding concern form.
36. The social work case reports have a record that Mrs X said when a care worker visited Mrs Y, they did not make any attempt to shower Mrs Y. It said the care worker told the family they were told not to shower her because of her arm injury. The social work records of the discussion a social worker had with Mrs X, say the care worker left after two minutes.
37. The social work records say a care provider manager had checked the care workers care notes for 14 January, which say Mrs Y had had a body wash that day.
38. The social worker who completed the safeguarding concern under ‘details of concern’ has recorded that the care worker told the family they were not able to shower Mrs Y because of her arm and there was no hot water available at the property. This form is recorded as saying the care worker took Mrs Y to the bathroom for a wash after the family insisted but was there for only ten minutes.
39. On 18 January a social work manager and a safeguarding co-ordinator held a meeting about the safeguarding concern Mrs X had raised. Following the meeting, the safeguarding coordinator made a record of the discussion, saying more information was needed about why the level of care was now an issue and that more information was needed about the alleged pressure sores.
40. Following the meeting, the safeguarding coordinator contacted Mrs X and the care provider separately. The safeguarding coordinator recorded the outcome being sought as improving communication between the family and the care provider.
41. The safeguarding coordinator said that neglect was not a concern, and the form suggests Mrs X was contacted by the safeguarding coordinator on 24 January at which point the case was closed.
42. The Council did not seek out further information about Mrs Y’s alleged pressure sores, but the safeguarding coordinator has recorded there had been no issues raised about these by the hospital.
43. The safeguarding coordinator has recorded the risk to Mrs Y as being reduced and notes in the closure record that Mrs X’s concern was ‘partly substantiated’. The form also says that better communication between Mrs Y’s family and the care provider would be improved by use of a smart phone application.
44. In April, Mrs X recontacted the Council about her previous safeguarding referral asking about the outcome and any lessons learned. Following this, the safeguarding coordinator sent Mrs X a text message update, telling her the case had been closed after better communication had been promised.
45. The safeguarding coordinator noted on the case records, this update was being sent as a reminder as this update had previously been given.
46. In May, Mrs X made a formal complaint to the Council and a social work manager made follow up enquiries with the care provider.
47. Mrs X told me she was concerned the care workers had not been showering Mrs Y because two care provider managers had given her conflicting information about whether Mrs Y could have been showered during the time her arm was in a plaster cast and this caused uncertainty.
48. In a complaint response to Mrs X, the Council said it had identified additional learning for the safeguarding co-ordinator in relation to making more enquiries about Mrs Y’s alleged pressure sore.

My findings

Care Provision

49. The care provider discussed Mrs Y’s care needs with her immediately following her injury. Mrs Y had asked for a body wash while she was in discomfort. The care provider told her at the time she would need a cover for her cast.
50. When the care provider was updated that Mrs Y’s condition was improving it reminded Mrs Y she would need a cover for her cast. A care worker had offered to obtain one for her the following week if Mrs Y had not already got one by then.
51. I can understand Mrs X will have a view that Mrs Y was not being showered and had her care neglected because the care provider adopted an unhelpful position in deciding Mrs Y would need a proper cover before she could be showered.
52. Mrs X will likely have this view because she says two managers gave her conflicting advice about their corporate approach. However, on balance, the evidence suggests Mrs Y was not able to take a shower before 14 January at the earliest. In addition, the care provider had recorded it would take steps to obtain a cover the following week.
53. There was no fault in how the care provider approached Mrs Y’s washing requirements.
54. I acknowledge there are two slightly differing accounts of what the social worker has recorded as the family concerns about care provided to Mrs Y on 14 January (paragraphs 36-38 of this report). The weight of evidence including the care notes, suggest Mrs Y was given a body wash.
55. I am unable to decide whether the alleged pressure sore the family discovered on 13 January could have been discovered sooner or prevented.
56. Because there is no detailed information about the extent of care provided on 14 January, I cannot make a finding as to any fault in the care worker not recording any injury to Mrs Y after their visit that day.
57. The Council properly responded to Mrs X’s request for a revised care plan on 13 January.

Safeguarding response

58. The Care Act 2014 says the Council must make enquiries if it thinks a person may be at risk of neglect. The Council made enquiries with Mrs Y’s family to understand their concerns and discussed these with the care provider.
59. The Council decided the appropriate response was to improve communication between the family and Mrs Y’s family and Mrs X was aware of this at the time. This is not fault; the Council took a decision it was able to take based upon the information it had.
60. The Council acknowledged there was additional learning to be taken about professional curiosity concerning making enquiries about allegations of pressure sores and this is appropriate.
61. Mrs X complained the Council did not provide an update about the outcome of the safeguarding investigation until she received a text message sent by the Council in April. It is likely Mrs X was informed at the point the safeguarding enquiry was concluded in January.

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Final decision

62. There was no fault in the Council’s actions.

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Investigator's decision on behalf of the Ombudsman